ECM Editorial: MNsure, still a work in progress

In March, Gov. Mark Dayton told members of the ECM Editorial Board that the problem-plagued rollout of MNsure, Minnesota’s new health care exchange, was the biggest disappointment of his first term.

On April 30, a month after the first enrollment period had closed, the DFL governor boasted in his State of the State address that more than 206,000 people have obtained affordable coverage through the exchange.

Dayton has reason to feel relieved by the new figure. Enrollment has far outpaced a March 31 goal of 135,000 people, which MNsure officials had downgraded from previous goals.

But Dayton’s lament bears remembering. MNsure isn’t out of the woods yet, and the state hasn’t fully answered for the technical problems and accountability lapses that were so apparent when enrollment opened last Oct. 1.

Too many Minnesotans encountered confusion and worry — or no response at all — as they tried to navigate an ill-functioning, crashing website or get help from an overloaded call center.

The exchange, built with $155 million in Affordable Care Act grants, is not on pace to reach its 2016 enrollment goal of 1.3 million people, according to consulting firm Optum, which reviewed the rollout.

And it’s unclear whether MNsure can operate well into the future without state subsidies. State exchanges under the ACA must be self-sustaining by 2015. MNsure’s goal, enshrined in state law, is to pay for itself by collecting a portion of the insurance premiums sold through the exchange. Is that achievable?

Answers are forthcoming through a review by the respected Office of the Legislative Auditor, and there’s time for MNsure officials to continue making improvements before the next enrollment period opens on Nov. 15.

MNsure is a worthy response to the Affordable Care Act. We endorse the federal law’s goals of reducing the number of uninsured, relieving families of crippling medical debts and improving overall health outcomes. We think Minnesota made the right call to form a state exchange because its citizens are apt to get better deals and better coverage than on the federal exchange.

Political recriminations over MNsure and the ACA will continue through the November election. Republican leaders say the exchange has been a disaster and that their ideas on health care have been ignored. Meanwhile, the legislative auditor has outlined crucial questions to be answered by the end of the year, including:

To what extent has MNsure reduced the number of Minnesotans without health insurance? What are the characteristics of the new enrollees? Have marketing and outreach efforts been effective?

What caused the enrollment problems, and how much was paid to fix them? Has MNsure’s Dayton-appointed board of directors exercised sufficient oversight?

Finally, how has MNsure’s performance compared with those of other state exchanges and the federal exchange? Many were poorly tested and unready to go live.

In MNsure’s case, reporting by the Star Tribune states that officials — including Dayton — knew well before the Oct. 1 rollout that the product wasn’t ready for prime time. Audits pointed to dozens of problems, including the website’s incompatibility with some Internet browsers.

As weeks passed, insurers complained of receiving insufficient or inaccurate data from MNsure. In December, Dayton sent a letter to IBM, a MNsure software vendor, blasting the company’s Curam product.

Also in December, MNsure’s executive director, April Todd-Malmolv, resigned after being criticized for taking a vacation around Thanksgiving, when MNsure’s problems were mounting en route to a Jan. 1 deadline to get as many people enrolled for 2014 as possible. Todd-Malmolv’s resignation seemed to confirm the impression of a program in disarray.

Dayton didn’t help transparency’s cause last month when his office reportedly asked Human Services Commissioner Lucinda Jesson not to testify before the Legislature’s MNsure oversight committee, which had requested her presence in response to the Star Tribune’s reporting about the leadup to the flawed rollout.

Despite MNsure’s problems, a rapid influx of enrollees this spring demonstrated the program is capable of rebounding and offers products that Minnesotans need and want.

By April 7, MNsure reported, nearly 180,000 Minnesotans had signed up through the exchange. A total of 47,560 had enrolled in qualifying private health plans. Another 95,390 were newly enrolled in Medical Assistance (Medicaid), and 36,600 were found to be eligible for MinnesotaCare subsidies.

As ECM Editorial Board members periodically examine health-related topics throughout 2014, those numbers tell us that Minnesota is healthier with MNsure than without it.

The exchange is a “new and important part of state government,” the legislative auditor’s office said in a briefing paper. “Assessing MNsure’s performance will be complex, and the health exchange’s impact may not be fully apparent in its first year of operation.”